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目的观察外源性肺表面活性物质对小儿体外循环肺保护的临床疗效。方法将２４例先天性心脏病室间隔缺损伴肺动脉高压患儿，随机分为对照组和用药组。测定两组患儿围术期肺的动态顺应性、氧合指数、气管插管维持时间、肺循环血浆丙二醛含量及肺组织超微结构观测。结果体外循环后各时点用药组肺动态顺应性显著高于对照组（Ｐ＜００５），氧合指数显著低于对照组（Ｐ＜００１）。对照组气管插管维持时间为１３８小时，而用药组为８９小时（Ｐ＜０００１）。肺循环血浆丙二醛含量显著高于用药组（Ｐ＜００１）。肺组织超微结构观察证实用药组肺损伤的程度也较对照组明显减轻。结论预防性应用外源性天然肺表面活性物质对小儿室间隔缺损伴肺动脉高压患者体外循环术后肺功能不全有明显的保护作用。
Objective To observe the clinical effect of exogenous pulmonary surfactant on pulmonary protection during cardiopulmonary bypass in children. Methods 24 cases of congenital heart disease ventricular septal defect with pulmonary hypertension in children were randomly divided into control group and medication group. The perioperative lung compliance, oxygenation index, endotracheal intubation maintenance time, pulmonary plasma MDA levels and lung ultrastructure were measured. Results The pulmonary dynamic compliance of the medication group at each time point after cardiopulmonary bypass was significantly higher than that of the control group (P <005), and the oxygenation index was significantly lower than that of the control group (P <001). The control group tracheal intubation maintenance time of 13 8 hours, while the medication group was 8 9 hours (P <0 001). Pulmonary circulation plasma malondialdehyde content was significantly higher than the medication group (P <0 01). Ultrastructural observation of lung tissue confirmed that the degree of lung injury in the treatment group was significantly reduced compared with the control group. Conclusion Preventive use of exogenous natural pulmonary surfactant has a significant protective effect on pulmonary insufficiency after cardiopulmonary bypass in children with ventricular septal defect and pulmonary hypertension.